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The Honolulu Advertiser
Posted on: Sunday, April 9, 2006

Contraceptives for women aplenty

By SHARI RUDAVSKY
Gannett News Service

Nearly half a century after the introduction of The Pill, ways to prevent pregnancy abound. There's the tried and true birth-control pills, diaphragms, condoms and, yes, abstinence.

And if you're looking to protect against sexually transmitted diseases, the male condom is still your best bet, but if you and your partner are healthy, there are many new products from which to choose. Here's a rundown of newer products out there:

ESSURE

  • What it is: A new type of irreversible sterilization for women that involves placing coils inside the fallopian tubes. This will cause scarring, which acts as a barrier to sperm.

  • Pros: Can be done as an outpatient or office procedure in 20 to 35 minutes under local anesthesia. Traditional methods are done under general anesthesia.

  • Cons: Until you confirm the scarring has blocked the tubes, usually about three months after the procedure, you must use other contraception.

  • Cost: $2,000 to $5,000. Some insurance companies will cover this procedure.

  • Effectiveness: 99.8 percent.

    CONTINUOUS DOSE PILL, SEASONALE

  • What it is: Birth control pills that allow you to have your period once every three months instead of every month.

  • Pros: Can be a plus for women who develop anemia or severe cramps around their menses.

  • Cons: Between periods, you're more likely to have bleeding or spotting than if you're on a traditional birth-control pill.

    As with all pills combining estrogen and progesterone, side effects can include breast tenderness, bleeding, nausea, bloating, headaches and moodiness. More serious risks include increased chance of stroke, heart attacks and blood clots.

    Combined hormonal methods are not usually recommended for women older than 35 who smoke, or those with a history of clotting or a family history of early heart attack or stroke, says women's health nurse practitioner Cristy Coner with Planned Parenthood.

  • Cost: $19 a month.

  • Effectiveness: About 99 percent effective with perfect use. With typical use, about 92 percent effective.

    THE MINI-PILL

  • What it is: A progesterone-only pill that's taken every day.

  • Pros: Considered safer than the estrogen-hormonal methods without causing any of the bone loss of Depo-Provera. Particularly good for older women concerned about the clot risks from traditional pills, or for nursing mothers, Coner says.

  • Cons: In order for this to be effective, you have to take it at the same time each day. If you're more than three hours late, it ceases to be effective and could cause some irregular bleeding, Coner says.

  • Cost: About $19 per month.

  • Effectiveness: With typical use, 95 percent. If used perfectly, 99 percent effective.

    CYCLEBEADS

  • What it is: Aid for natural family planning, developed by Georgetown University's Institute for Reproductive Health. This method consists of a strand of beads that allows a woman to chart when she is likely to be fertile so she can avoid having unprotected sex on those days.

    Red bead signifies first day of bleeding and you move the black ring one bead each day. Brown days are safe; white are not.

  • Pros: Natural, allows for unprotected sex without (too much) worry. "An important nonhormonal option," says Victoria Jennings, director of the institute that developed the beads.

  • Cons: Recommended only for women whose cycle is 26 to 32 days. Does not protect against sexually transmitted diseases.

  • Cost: $13.95, available online at www.cyclebeads.com.

  • Effectiveness: If used properly, CycleBeads can be more than 95 percent effective. If used improperly, pregnancy rates are much higher.

    NUVARING

  • What it is: NuvaRing is made of flexible plastic about 2 inches in diameter that's inserted into the vagina for three weeks. It releases low doses of estrogen and progestin, the hormones found in birth-control pills.

  • Pros: You don't have to remember to take a pill every day. This also has less estrogen than other combined hormonal methods, says Dr. Cameual Wright of Ob-Gyn Specialists of Indiana.

    The ring also may prevent nausea and vomiting, which some women experience with contraceptive pills.

  • Cons: Same risks as birth-control pills. You must remove the ring after three weeks and replace it with a new ring a week later.

  • Cost: About $25 a month.

  • Effectiveness: About 99 percent effective with correct use.

    THE PATCH

  • What it is: A light tan square placed on the abdomen, shoulder, buttocks or back that releases estrogen and progesterone that are absorbed through the skin. You change it every week for three weeks and then go patchless for a week while you menstruate.

  • Pros: You don't need to think about birth control. Could be a good option for those who can't tolerate birth-control pills.

  • Cons: Same side effects as other estrogen methods, although a recent study showed that users get 60 percent more estrogen with the patch than with comparable measures, raising the question of whether the risks are greater.

    Some users may develop hives or skin irritation.

    Users who weigh more than 190 pounds may not get the same benefits as those who weigh less, says Dr. Indy Lane of Brillhart Ob-Gyn, based at Community Hospital North in Indianapolis.

  • Cost: About $30 a month.

  • Effectiveness: 99 percent when used correctly.

    DEPO-PROVERA

  • What it is: A progesterone shot that you receive every three months in your arm or hip. Women may even inject themselves, Lane says.

  • Pros: You only have to get the shot every three months. Because it has no estrogen, none of the side effects associated with that hormone apply. Most women on Depo stop their period, though some may have some irregular bleeding.

  • Cons: A recent study showed that women on Depo-Provera may experience some loss of bone density.

    In addition, the shots can cause temporary infertility for as long as a year to 18 months after you stop using them, experts say.

  • Cost: About $55 per shot.

  • Effectiveness: 99.7 percent.

    TODAY SPONGE

  • What it is: A disposable device made of polyurethane foam containing spermicide.

  • Pros: Can be left in place for 24 hours without having to replace the spermicide, as one would need to do with a diaphragm.

  • Cons: You have to wait at least six hours after intercourse and then remember to remove it. Good for only 24 hours.

  • Cost: About $10 for a pack of three.

  • Effectiveness: 89 percent to 91 percent effective when used correctly. With typical use, it's 84 percent to 87 percent effective.

    MIRENA IUD

  • What it is: An intrauterine device that's professionally inserted and removed that releases progesterone slowly into your uterus. Must be replaced every five to seven years.

  • Pros: Good for women who want to space out their children, Wright says. Can make periods lighter and, in some women, will end periods altogether.

  • Cons: The progesterone in this IUD may contribute to more headaches and tiredness than are associated with the copper IUD, says Dr. John Stutsman, an assistant professor of clinical obstetrics and gynecology with the Indiana University School of Medicine.

    It has the same risk as other progesterone-only products.

    As with the copper IUD, if you get a sexually transmitted disease while using one of these devices, it can be more of a problem.

    And if you get pregnant while using an IUD, the risk of an ectopic (outside the uterus) pregnancy is higher.

  • Cost: About $425 plus a doctor's fee for inserting the device.

  • Effectiveness: 99 percent.